Genetic counseling, a specialized form of cancer risk communication, has been considered a "Black Box" as few studies have investigated the content of genetic counseling. This R03 applicant is designed to examine the content of genetic counseling sessions for hereditary BRCA1/2 mutations (associated with increased risk of breast-ovarian cancer) and relate it to survey data collected before and after genetic counseling. The applicant's research has shown that individuals continue to have variable levels of knowledge of cancer genetics and subjective risk after genetic counseling for hereditary BRCA1/2 mutations. The Self-Regulation Model (SRM) is a useful framework for understanding and, potentially improving, the communication of cancer genetic information in genetic counseling sessions. Consistent with the SRM, specific aims of this R03 applicant include understanding genetic counseling with regard to: (1) the socio-cultural context, (2) the self, (3) cognitive and affective factors, (4) health behaviors, and (5) appraisal of the effectiveness of health behaviors. This applicant plans to transcribe, code, and analyze genetic counseling audiotapes (N=97) recorded as part of a longitudinal survey (before counseling, after counseling, after test results, 6 months after test results) study of Ashkenazi Jewish individuals receiving genetic counseling and testing for BRCA1/2 mutations. Survey assessments included knowledge of cancer genetics, negative affect, perceived risk, practice of health behaviors, and perceived effectiveness of health behaviors. Genetic counseling audiotapes will be analyzed with NVivo7 and Linguistic Inquiry &Word Count (LIWC) Software for socio-cultural, self, affective, and cognitive content. Using a mixed methods approach, coded transcripts based on the SRM will be used to link content in genetic counseling to the outcomes of knowledge of cancer genetics, negative affect, perceived risk of cancer and of having a mutation, practice of health behaviors, and perceived effectiveness of health behaviors. The PI will use the results of this R03 project and her unique training in Social/Health Psychology, Genetic Counseling, and Behavioral Science to develop interventions guided by the SRM to improve knowledge, worry, and accuracy of perceived risk in the short-term and to enhance appropriate cancer screening in the long-term. Genetic counseling, a specialized form of cancer risk communication, has been considered a "Black Box" as few studies have investigated the content of genetic counseling. This applicant is designed to link the content of genetic counseling for hereditary BRCA1/2 mutations (associated with increased risk of breast-ovarian cancer) to the outcomes of knowledge of cancer genetics, negative affect, perceived risk, practice of health behaviors, and perceived effectiveness of health behaviors, using the Self-Regulation Model. The goal of this line of research is to improve cancer risk communication in genetic counseling and to enhance appropriate cancer screening for individuals at risk for familial/hereditary cancers.